Avaliação da conduta conservadora na lesão intraepitelial cervical de alto grau

Abstract

OBJECTIVE:To analyze the association between conservative management of high-grade cervical squamous intraepithelial lesions and recurrence rates and age groups. METHODS:Cross-sectional, retrospective, analytical observational study of 509 women (aged 15 to 76) with abnormal Pap smears attending a public reference center in the city of Maringá, southern Brazil, from 1996 to 2006. Data was collected from medical records, and the variables defi nitive diagnosis, type of treatment provided, occurrence of high-grade cervical squamous intraepithelial lesions and recurrence were studied. Pearson's chi-square test and Fisher's exact test were used in the statistical analyses. RESULTS:There were 168 cases of cervical high-grade cervical squamous intraepithelial lesions, of these, 31 were treated with cold-knife conization, 104 loop electrosurgical excision procedure, 9 hysterectomy and 24 conservative treatment (i.e., clinical and cytological follow-up or cervical electrocoagulation). A total of 8 (33.3%) women receiving conservative and 10 (6.9%) receiving non-conservative management had recurrent disease and this difference was statistically signifi cant (p=0.0009), PR = 4.8 (95%CI 2.11;10.93). Three (30.0%) women among those undergoing clinical and cytological follow-up and fi ve (35.7%) among those submitted to cervical electrocoagulation had recurrent disease within three years, but the difference was not signifi cant (p=0.5611). Recurrent rates in those younger and older than 30 were 13.8% (7 women) and 12.2% (11 women) (p = 0.9955). CONCLUSIONS:Age is not a predictor of disease recurrence. Conservative treatment is only recommended in exceptional situations due to its high recurrence rates. Careful cytological and colposcopic follow-up is required for three years when most recurrences occur.

Avaliação do Seguimento de Mulheres com Exames Citopatológicos Alterados de acordo com as Condutas Preconizadas pelo Ministério da Saúde do Brasil em Goiânia, Goiás

“…Por esse motivo, a observação das normas e os encaminhamentos corretos são parâmetros importantes para o melhor desempenho do programa de rastreamento e controle do câncer do colo do útero, excluindo assim procedimentos e condutas inadequadas, que podem gerar custos adicionais 6 . além de ser uma alternativa econômica, a conduta preconizada é viável e simples, podendo ser realizada em consultório ginecológico e uaBs 22 .…”